Boat Insurance Quote - JW Davis Insurance Brokers

Berthing & Navigation:
If you sign a “Hold Harmless” agreement with your Yacht Club or Marina you must forward a copy of this agreement to us immediately:
Summer
Location:
Mooring Berth:
Winter
Location:
Lay-up Berth:
From:
YYYY slash MM slash DD

Lay-up Coverage: Coverage contemplates a Lay-up Period from November 15th to March 31st. If lay-up period is different, please indicate.
To:
YYYY dash MM dash DD

Lay-up Coverage: Coverage contemplates a Lay-up Period from November 15th to March 31st. If lay-up period is different, please indicate.
Is extension of Navigation Limits required?
Describe:

Qualifications and experience of all operators:
Name 1:
First Last
Date of Birth 1
YYYY slash MM slash DD
Have you previously owned a pleasurecraft
No. of Years
Number of years of experience as operator
Years of experience this type of vessel
Name #2
Name 2:
First Last
Date of Birth 2
YYYY dash MM dash DD
Have you previously owned a pleasurecraft
No. of Years
Number of years of experience as operator
Years of experience this type of vessel
Name #3
Name 3:
First Last
Date of Birth 3
YYYY slash MM slash DD
Have you previously owned a pleasurecraft
No. of Years
Number of years of experience as operator
Years of experience this type of vessel
Name #4
Name 4:
First Last
Date of Birth 4
YYYY slash MM slash DD
Have you previously owned a pleasurecraft
No. of Years
Number of years of experience as operator
Years of experience this type of vessel
Boat courses taken:
Describe:
Loss History:
Please list in detail any known and/or reported boating, property, automobile losses and/or infractions for the past five years for all operators:
Please list previous Insurer:*
Has insurance been refused or cancelled by any Company?

Manufacturer and Model of Vessel: